Hand held surgical device

ABSTRACT

Hand-held surgical assembly for use in performing a laparoscopic medical procedure, comprising a housing. An actuator tube having a bore therein is slidably mounted in the housing. A handle operated mechanism is carried by the housing for causing reciprocatory movement of the actuator tube assembly within the housing.

This application is a continuation-in-part of application Ser. No.07/806,666, filed on Dec. 13, 1991, now U.S. Pat. No. 5,433,725.

This invention relates to a hand-held surgical device and tools for usetherewith, an assembly and method, and more particularly to such adevice, tools, assembly and method for use in performing medicalprocedures.

Surgical devices for use in endoscopic procedures have heretofore beenprovided. These typically, however, have been separate individualdevices or tools used independently. This is particularly true for toolsfor use in laparoscopy in which the tools usually have been expensive,fine precision metal tools. There is therefore a need for tools whichare much less expensive which can be made disposable if so desired, andwhich can be utilized in conjunction with a hand-held surgical device.

In general, it is an object of the present invention to provide ahand-held surgical device and tools for use therewith, an assembly and amethod for utilizing the same.

Another object of the invention is to provide a device of the abovecharacter which is provided with a hollow bore through which the toolscan be inserted.

Another object of the invention is to provide a device of the abovecharacter in which the device includes a trigger mechanism for causing alinear thrusting motion which is utilized for actuating tools disposedin the bore of the device.

Another object of the invention is to provide a device of the abovecharacter in which the device includes a scissors-like mechanism forcausing a linear thrusting motion which is utilized for actuating toolsdisposed in the bore of the device.

Another object of the invention is to provide a device of the abovecharacter in which the bore extends through a slidably mounted sleeve orbarrel.

Another object of the invention is to provide a device of the abovecharacter in which the sleeve can be rotated.

Another object of the invention is to provide a device of the abovecharacter in which the tools can be locked onto the device for actuationof the tools and for rotation of the tool.

Another object of the invention is to provide a device of the abovecharacter in which tools can be readily inserted and removed.

Another object of the invention is to provide a device and tools for usetherewith of the above character in which substantially fluid-tightseals are created between the tool and the device when a tool isinserted in the device.

Another object of the invention is to provide a device and tools for usetherewith of the above character in which spring-loaded members areutilized.

Another object of the invention is to provide a device and tools for usetherewith of the above character with which electrocautery operationscan be performed.

Another object of the invention is to provide a device and tools for usetherewith in which the tools can be made disposable if desired.

Another object of the invention is to provide a device of the abovecharacter which can be sterilized.

Another object of the invention is to provide a device of the abovecharacter which is particularly suited for use in gynecological surgicalprocedures.

Another object of the invention is to provide a device of the abovecharacter which has been simplified and which has been provided withfewer functions to be used by a surgical assistant.

Another object of the invention is to provide a device of the abovecharacter which can be utilized by a surgical assistant which excludeselectrical and fluid functions.

Another object of the invention is to provide a device of the abovecharacter which has a long lifetime and which has lower maintenancecosts.

Additional objects and features of the invention will appear from thefollowing description of the particular embodiment as set forth indetail in conjunction with the accompanying drawings:

FIG. 1 is a side elevational view of hand-held surgical deviceincorporating the present invention.

FIG. 2 is a top plan view looking along the line 2--2 of FIG. 1.

FIG. 3 is a rear elevational view looking along the line 3--3 of FIG. 1.

FIG. 4 is a cross-sectional view taken along the line 4--4 of FIG. 2.

FIG. 5 is a cross-sectional view taken along the line 5--5 of FIG. 4.

FIG. 6 is a cross-sectional view taken along the line 6--6 of FIG. 4.

FIG. 7 is a cross-sectional view taken along the line 7--7 of FIG. 4.

FIG. 8 is a cross-sectional view taken along the line 8--8 of FIG. 1.

FIG. 9 is a cross-sectional view taken along the line 9--9 of FIG. 1.

FIG. 10 is a side elevational view of a tool incorporating the presentinvention.

FIG. 11 is a cross-sectional view of the tool shown in FIG. 10.

FIG. 12 is a cross-sectional view taken along the line 12--12 of FIG.11.

FIG. 13 is a partial cross-sectional view of a device incorporating thepresent invention with a tool mounted therein.

FIG. 14 is a partial side elevational view partly in cross-section ofthe distal extremity of a tool incorporating the present invention.

FIG. 15 is a top plan view of the tool shown in FIG. 14 looking alongthe line 15--15 of FIG. 14.

FIG. 16 is a cross-sectional view taken along the line 16--16 of FIG.14.

FIG. 17 is a cross-sectional view taken along the line 17--17 of FIG.14.

FIG. 18 is a side elevational view of a distal extremity of another toolincorporating the present invention.

FIG. 19 is a view looking along the line 19--19 of FIG. 18.

FIG. 20 is a view of the distal extremity of another tool incorporatingthe present invention.

FIG. 21 is a top plan view looking along the line 21--21 of FIG. 20.

FIG. 22 is a partial side elevational view of another tool incorporatingthe present invention.

FIG. 23 is a plan view partially in cross-section looking along the line23--23 of FIG. 22.

FIG. 24 is a partial side elevational view of the tool shown in FIG. 22but of the side opposite that shown in FIG. 22.

FIG. 25 is a cross-sectional view taken along the line 25--25 of FIG.23.

FIG. 26 is a cross-sectional view of the distal extremity of anothertool incorporating the present invention.

FIG. 27 is a top partial plan view of another tool incorporating thepresent invention.

FIG. 28 is a cross-sectional view taken along the line 28--28 of FIG.27.

FIG. 29 is a cross-sectional view of an adapter assembly for use with atool when it is inserted into an endoscopy device of the presentinvention.

FIG. 30 is a side elevational view of an assembly incorporating thepresent invention in which a tool is inserted into an endoscopy deviceand in which an adapter assembly is mounted in the tool.

FIG. 31 is a side elevational view of a hand-held surgical deviceincorporating another embodiment of the present invention utilizing ascissors-type actuation mechanism.

FIG. 32 is a side elevational view similar to FIG. 31 with certainportions broken away and shown in section.

FIG. 33 is an enlarged cross-sectional view taken along the line 33--33of FIG. 32.

FIG. 34 is an enlarged cross-sectional view taken along the line 34--34of FIG. 32.

FIG. 35 is an enlarged cross-sectional view taken along the line 35--35of FIG. 32

FIG. 36 is an enlarged schematic view showing the manner in which theportion of ratchet mechanism shown in FIG. 35 operates.

FIG. 37 is an enlarged cross-sectional view of the nose cone portion ofthe device shown in FIG. 32.

FIG. 38 is a side elevational view incorporating another embodiment of ahand-held device particularly suitable for use by a surgeon's assistant.

FIG. 39 is a side elevational view of the device shown in FIG. 37 with atool mounted therein and with certain parts broken away to shown certainparts in section.

FIG. 40 is a cross-sectional view taken along the line 40--40 of FIG.39.

FIG. 41 is a cross-sectional view taken along the line 41--41 of FIG.39.

FIG. 42 is an exploded isometric view of the device shown in FIG. 37.

FIGS. 43A, 43B and 43C are schematic representations showing the variousmodes of operation of the ratchet mechanism used in the device shown inFIG. 44.

FIG. 44 is a side elevational view of another embodiment of a hand-heldsurgical device incorporating the present invention particularlysuitable for gynecological surgical procedures.

FIG. 45 is a side elevational view of the device shown in FIG. 43 withcertain portions broken away.

FIG. 46 is a cross-sectional view taken along the line 45--45 of FIG.44.

FIG. 47 is a cross-sectional view taken along the line 46--46 of FIG.44.

FIG. 48 is a cross-sectional view taken along the line 47--47 of FIG.44.

In general, the hand-held surgical assembly for use in performing amedical procedure is comprised of a hand-held endoscopy device having abore extending therethrough. It also consists of a tool removablymounted in the bore. Cooperative means is provided for establishing asubstantially fluid-tight seal between the bore and the tool. An adapterassembly is mounted on the tool.

More in particular, as shown in the drawings of FIGS. 1-9, the hand-heldsurgical device 31 consists of a housing 32 which is provided with anupper cylindrical portion 33 and a handle portion 34 in the form of apistol grip adapted to be grasped and held by a single human hand. Thehousing 32 is preferably formed of a material which can repeatedlywithstand autoclave sterilization, ethylene oxide sterilization or gammaradiation sterilization. One material found to be particularly suitablefor this purpose is a plastic identified as Ultem, manufactured by theGeneral Electric Company. Such a material is capable of withstandinghigh temperatures and is very durable. The housing 32, utilizing such aplastic, is formed in two parts 32a and 32b (see FIG. 3) which arejoined together along a parting line 36. A pair of spaced apart bosses37 (see FIG. 4) are provided on each of the parts 32a and 32b so thatthe two parts 32a and 32b can be fastened together by suitable meanssuch as screws 38 extending into the bosses and forming the two parts32a and 32b into a unitary housing 32.

An actuator tube assembly 41 is mounted in the upper cylindrical portion33 for limited axial movement. The actuator tube assembly 41 is providedwith a bore 42 which extends therethrough. The actuator tube assembly 41consists of two tubes 43 and 44 in which tube 43 is formed of a suitableplastic such Ultem, hereinbefore identified, and the tube 44 is formedof a suitable metal such as stainless steel. The metal tube 44 has itsproximal extremity fixed within the distal extremity of the plastic tube43 so that the bore 42 is continuous and has the same diameter extendingfrom the plastic tube 43 into the metal tube 44. The actuator tubeassembly 41 is provided with proximal and distal extremities 46 and 47.These proximal and distal extremities 46 and 47 are axially guidedwithin the housing by sidewise extending guide portions 48 and 49 (seeFIG. 6) formed integral with the housing parts 32a and 32b havingsemicircular recesses 51 which are adapted to receive the proximalextremity 46 of the actuator tube assembly 41. Similarly, upper andlower guide portions 53 (see FIG. 4) formed integral with the parts 32aand 32b and having semicircular recesses 54 guide the distal extremity47 of the actuator tube assembly 41. Means is provided for rotating theactuator tube assembly 41 about its axis and consists of a thumb wheelor knob 56 (see FIGS. 1 and 4) which encircles the actuator tubeassembly 41 and which extends through a slot 57 provided in the housing32 so that the thumb wheel or knob 56 can be actuated by a finger of thehand while the hand is holding the pistol grip-shaped handle portion 34.The thumb wheel 56 is provided with spaced apart, axially extendingraised portions 58 to facilitate frictional engagement by a finger ofthe wheel or knob 56. Cooperative mating means is provided between thethumb wheel 56 and the plastic tube 43 of the actuator tube assembly 41.The cooperative mating means consists of a pair of diametrically spacedapart axially extending keys 61 which are slidably mounted in the slots62 extending diametrically outwardly from a bore 63 provided in thethumb wheel 56. The thumb wheel 56 is retained in a fixed longitudinalposition with respect to the actuator tube assembly 41 by the guideportions 53 and wall portions 64 formed integral with the housing parts32a and 32b, and having semicircular recesses 66 (see FIG. 4).

Means is provided for causing reciprocatory movement of the actuatortube assembly 41 for a suitable distance, as for example 125 andconsists of yoke-like lever arm 71 formed of a suitable plastic such asUltem. The yoke-like member 71 is provided with a pair of pins 72extending from opposite sides thereof that are pivotally mounted inrecesses (see FIG. 7). As can be seen, the pins 72 are provided at theupper extremity of the lever arm formed by the member 71 to provide asubstantial mechanical advantage, as for example a 4-to-1 mechanicaladvantage. The upper extremity of the yoke-like lever arm 71 is providedwith a U-shaped or forked portion 76 having generally circular upperextremities 77 (see FIG. 4), which are disposed on opposite sides of theplastic tube 43 between circumferentially extending spaced apart flanges78 and 79 provided centrally of the plastic tube 43 of the actuator tubeassembly 41. As can be seen from FIG. 4, the upper circular extremities77 fit relatively closely within the flanges 78 and 79. The lowerextremity of the yoke-like lever member 71 is pivotally connected to atrigger bar 81 by pin-and-slot connections in which elongate slots 82are provided on opposite sides of the yoke-like member 71 that receivethe opposite extremities of a pin 83 mounted in the trigger bar 81. Thetrigger bar 81 is mounted within the housing 32 for movement in adirection which is substantially parallel to the axis of the actuatortube assembly 41. The trigger bar 81 travels between upper and lowerwall portions 86 and 87 which are formed integral with the housing parts32a and 32b (see FIG. 5). In addition, the trigger bar 81 is guided byupper and lower guide portions 88 and 89 also formed integral with thehousing parts 32a and 32b and which extend inwardly and slidably seat ingrooves 91 and 92 provided on opposite sides of the trigger bar 81.

Spring means is provided for yieldably urging the trigger bar 81 to theleft as viewed in FIG. 4 and consists of a leaf-spring 96 which has oneleaf 97 engaging the interior of the housing 32 and the other end 98engaging the lower extremity of the yoke-like member 71. The apex 99 ofthe spring can be secured if desired to the interior of the housing 32by a screw 101. Means is provided for limiting the travel of the triggerbar 81 to the left in the housing 32 as viewed in FIG. 4, and consistsof the yoke-like member 71 which restrains movement of the trigger bar81 because of the limitations in axial movement of the actuator tubeassembly 41 in the upper cylindrical portion 33.

The trigger bar 81 is provided with means whereby it is adapted to begrasped by fingers of the hand holding the handle portion 34. Such meansconsists of an elongate finger hole 106 which extends in a directionwhich is generally perpendicular to the axis of movement of the actuatortube assembly 41. It preferably is a size which is adapted to receive atleast two fingers of the hand, as for example the two fingers betweenthe index finger and the little finger or the index and middle fingersof the hand.

Means is provided for retaining the trigger bar 81 in a predeterminedposition against the force of the yieldable means provided by the leafspring 96 and consists of elongate sawtooth portions 109 which areprovided on opposite sides of the trigger bar 81. The portions 109 areadapted to be engaged by plungers 111 seated in a well 112 and extendingthrough a hole 113 provided in the housing 32. Each of the plungers 111is provided with two portions 111a and 111b with a space 114therebetween and an annular recess 115 so that the portions 111a and111b can be pressed together and snapped through the hole 113 andretained therein. The distal extremity of the plunger portion 111a isprovided with sawteeth 116 which are adapted to engage the sawteeth ofthe sawtooth portions 109. A wave washer 117 is provided in each of thewells 112, and is utilized for yieldably returning the finger-operatedplunger 111 into an out-of-engagement position. When the plunger 111 isengaged by a finger of the hand, as for example by the thumb on one sideor the index finger on another side, the plunger 111 can be pushedinwardly against the force of the wave washers or springs 117 to causethe sawteeth 116 to engage the sawtooth portions 109 to retain thetrigger bar 81 in a predetermined position. As soon as the sawtooth areengaged, the frictional engagement is sufficient to prevent the wavewashers from returning a plunger 111 to its home position. It is onlywhen the trigger bar 81 is moved that the wave washers 117 will causethe sawteeth 116 to disengage and to permit a plunger 111 to return toits home position.

The surgical device 31 also includes a barrel 121 which is provided witha bore 122 extending axially thereof and through the barrel 121. Thebarrel 121 can be formed of a suitable material such as stainless steel.The bore 122 can be of a suitable size, as for example 8 mm. However, itshould be appreciated that in connection with the present inventiondifferent barrels with different size bores can be provided, as forexample ranging from 6 to 12 mm bores. The barrel can have a suitablelength, as for example 8 to 14 inches. It is provided with a distalextremity 123 and a proximal extremity 124. The proximal extremity 124is mounted within an adapter 126 of Ultem in the form of a reducer thatis mounted in a metal tube 127 of a larger diameter. The diameter of themetal tube 127 is such so that the distal extremity of the metal tube 44can slidably fit therein to provide a substantially fluid-tight sealbetween the same, to in effect form a trombone-type seal permitting theaxial movement of the actuator tube assembly 41. The adapter 126 alsoforms a fluid-tight seal between the barrel 121 and the metal tube 127.The metal tube 127 is mounted in a fixed position with respect to thehousing 32 and is frictionally retained therein as shown particularly inFIGS. 4 and 8.

A nose cone 131 formed of a suitable material such as Ultem is mountedover the barrel and serves to reinforce the connection between thebarrel and the adapter 126 as well as the metal tube 127. The nose cone131 is threadedly mounted as shown on the distal extremity of thehousing 32.

The bore 42 is in axial alignment with the bore 122 provided in thebarrel 121 and is adapted to receive tools of various types ashereinafter described. Cooperative means is provided for establishing afluid-tight seal between the tool and the bore 32 and, as shown in FIGS.4 and 8, consists of valve means in the form of a valve member of thetype described in U.S. Pat. No. 5,141,498 dated Aug. 25, 1992. Thisvalve member 136 is seated within a cylindrical enlargement 137 providedat the proximal extremity 46 of the plastic tube 43. A cylindrical cap138 is threaded onto the cylindrical enlargement 137 (see FIG. 8) toretain the valve member 136 in place. The cap 138 is provided with anannular shoulder 139 which engages the valve member 136 and holds it inplace. The annular shoulder 139 is provided with serrations 140 on theproximal surface of the shoulder 139. The cap 138 is provided with ahole 141 which is in registration with the bore 42. The cap 138 isprovided with a bore 142 in alignment with the hole 141. An annularrecess 143 is provided within the bore 142.

The housing 32 is also provided with switching capabilities in the formof a switch 151 on the top of the housing 32 which serve electrocauteryfunctions. Switch 151 has three positions, a "central or off" position,and two depressed or "on" positions on opposite sides of the centralposition. One side of switch 151 is for higher power for cutting and theother side of switch 151 is for lower power for coagulation. Controlswitches 153 and 154 are provided on opposite sides of the housing ingeneral alignment with the switch 151 and also have three positions thesame as switch 151. One side of control switch 153 can be utilized forcontrolling the introduction of fluids through the bore 42, as forexample a saline or other irrigating solution which can be utilized forirrigating and cleansing the area of interest. The other side controlswitch 153 can be utilized to provide suction in the bore 42 to extractfluids, as for example saline solutions, which have been introduced forirrigation purposes as well as blood, bile, etc. The switch 154 can beutilized for controlling the same functions as switch 153. It can beseen that the switch 151 and the switch 153 have been positioned on thehousing so that they can be readily depressed by the index finger on theright hand while the surgical device 31 is being held by the right hand.Similarly the switch 151 and switch 154 can be depressed by the indexfinger of the left hand when the surgical device 31 is being held by theleft hand.

As hereinbefore pointed out the endoscopic device 31 is adapted to beused with tools of the type hereinafter described. In connection withsuch tools, cooperative mating means is provided whereby the tool isretained within the bore 42 and consists of L-shaped recesses 161 whichare formed exteriorly on the cylindrical enlargement 137 of the tube 43.These recesses 161 are adapted to mate with cooperative mating meansprovided on the tool as hereinafter described. By utilizing cooperativemating means of this type in form of a bayonet-type connection, a toolcan be inserted into the bore 42 and locked in place with a smallrotational movement. It also can be readily removed by unlocking with asmall rotational movement in an opposite direction and subsequentwithdrawal.

As hereinafter described, a plurality of tools are adapted to beutilized with the endoscopic device 31. One of such tools is shown inFIGS. 10, 11 and 12. This tool 166 as shown therein consists of anelongate inner tubular member 167 which is provided with a bore 168extending axially thereof and therethrough. The inner elongate tubularmember can be formed of a suitable material such as stainless steel andcan have a suitable exterior diameter such as 3 to 10 mm and by way ofexample 7 mm, and a suitable interior diameter of 2 to 9 mm and by wayof example 6 mm. The tubular member 167 can have a suitable length, asfor example ranging from 12 to 20 inches. It is provided with proximaland distal extremities 169 and 171.

A locking and actuation mechanism 172 is mounted on the proximalextremity 169. This mechanism 172 consists of an outer sleeve which isslidably mounted on the proximal extremity 169 of the inner tubularmember 167. The proximal extremity of the sleeve 173 is fixed to aslider clip 174. The slider clip 174 is formed of a suitable materialsuch as plastic and is provided with a serrated annulus 175 on itsdistal extremity adapted to engage the serrations 140 on the cap 138 ofthe hand held surgical device 31, the slider clip 174 is provided with apair of arms 176 spaced 180° apart extending parallel to the axis of thesleeve 173. Additional arms 176 can be provided if a furtherdistribution of linear forces is desirable. The arms 176 aresubstantially L-shaped and are provided with laterally extending legs177 which extend into slots 178 provided in a cylindrical slider cap179. The legs 177 are also provided with protrusions 180 which arerectangular in cross-section and extend outwardly so that they areadapted to seat in the annular recess 143 in the cap 138 as hereinafterdescribed. The cylindrical slider cap 179 is provide with an inwardlyand distally extending skirt 181 that is secured to the proximalextremity of the inner tubular member 167. Yieldable means in the formof a coil spring 182 is provided on the proximal extremity of the innertubular member 167 and has one end engaging the skirt 181 and has theother end engaging the slider clip 174 (see FIG. 11).

An outer sleeve 183 formed of a suitable material such as Ultem iscoaxially mounted on the slider cap 179 and engages a shoulder 184provided on the slider cap 179, and is maintained in engagementtherewith by a friction fit. The outer surface of the outer sleeve 183is provided with an annular groove 186 which is arcuate incross-section, as shown particularly in FIG. 10, that is disposedbetween the proximal and distal extremities of the outer sleeve 183. Asshown in FIG. 11, the proximal extremity 187 is provided with an annularinclined surface 188 that overlies the outwardly extending legs 177provided on the slider arms 176 to control their outward movement forpurposes hereinafter described. The distal extremity 189 is providedwith inwardly extending cylindrical protrusions 191 mounted thereonwhich are adapted to engage the L-shaped recesses 161 provided in thesurgical device 31 for forming cooperative locking means between thesame in the form of a bayonet-type lock.

A linkage 196 is provided in the tool 166 for actuating mechanisms ofthe type hereinafter described carried by the tool. This linkage 196consists of a cylindrical pin 197 which extends diametrically throughelongate slots 198 provided in the inner tubular member 167 and intoholes 199 provided in the sleeve 173. The slots 198 have theirelongations extending in the direction of the axis of the inner tubularmember 167. A link rod 201 is mounted within the bore 168 of the innertubular member 167 and is provided with a hole 202 through which the pin197 extends. The link rod 201 extends distally from the pin 197 and isused for a purpose hereinafter described. The pin 197 is retained withinthe holes 199 by a plastic shrink tube 206 formed of a suitableheat-shrinkable plastic and extending over the sleeve 173. Another pieceof shrink tube 207 is provided on the portion of the inner tube 167which is exposed beyond the distal extremity of the sleeve 173 andcovers all the distal extremity of the inner tubular member 167 exceptfor a gap 208 which is provided to permit slidable axial movement of thesleeve 173 with respect to the tubular member 167. A mechanism 211 ismounted on the distal extremity of the inner tubular member 167 which isadapted to be operated by movement of the link rod 201 by slidingreciprocal movement of the outer sleeve 173 with respect to the innertubular member 167.

Sealing means is provided in the proximal extremity of the slider cap179 and consists of a valve member 216 of the type described incopending application Ser. No. 07/757,343, filed Sep. 10, 1991, which isclamped in place so that it is in generally axial alignment with thebore 168 of the inner tubular member 167. The valve member 216 is heldin place by a cap 217 which threadedly engages a cylindrical extension218 of the skirt 181 of the slider cap 179. A hole 219 is provided inthe cap 217 which is in alignment with the valve member 216 and the bore168. The valve member serves to form a substantially fluid-tight sealbetween the cap and the open end of the bore 168 provided in the innertubular member 167.

The assembly 221 which is formed when a tool 166 is mated with ansurgical device 31 is partially shown in FIG. 13. This view shows themanner in which the locking and actuator mechanism 172 of the tool 166cooperates with the proximal extremity of the surgical device 31. Thetool 166 is taken by one hand and the surgical device 31 is grasped bythe other hand. The distal extremity of the tool is introduced throughthe bore 142 and through the valve member 136 and enters into the bore42 and thence into the bore 122 of the barrel 121. As the locking andactuator mechanism 172 is advanced so that it comes into engagement withthe proximal extremity of the housing 32, the tool 166 is rotated untilthe protrusions 191 come into engagement with the L-shaped recesses 161,then twisted slightly to lock the same into place by bayonet-typeconnection. At the same time, the proximal extremity of the cap 138 ofthe actuator tube assembly 41 is moved into the space between the outersleeve 183 and the legs 177 until the protrusions 180 seat in theannular recess 143 of the cap 138 to lock the cap 138 to the slider clip174. The serrated annulus 175 engages the serrations 140 on the shoulder139 so that the tool 166 will be rotated when the actuator tube assembly41 is rotated. As soon as this has been accomplished, the tool 166 hasbeen locked onto the endoscopy device 31 so that the tool 166 islongitudinally fixed with respect to the endoscopy device 31. When thespool-shaped outer sleeve 183 is locked onto the proximal extremity ofthe housing 32 of the endoscopy device, the actuator tube assembly 41can be moved axially with respect to the outer sleeve 183 and can berotated with respect thereto.

The actuator tube assembly 41 is actuated by movement of the trigger bar81 through the yoke-like member or lever arm 71 that has the circularextremities 77 disposed between the flanges 78 and 79. Movement of theactuator tube assembly 41, which in turn through its connection betweenthe cap 138 and the protrusions 180 of the arms 176 seated in theannular recess 43 causes movement of the sleeve 173. Movement of thesleeve 173 causes movement of the pin 197 in the slots 198 in the innertubular member 167 to cause movement of the actuator rod 201. As pointedout previously, only a relatively small amount of axial movement of theactuator tube assembly 41 is required and it is for this reason that theslots 178 and the slots 198 are of a relatively short length. Ashereinafter explained, this movement is adequate to operate themechanism 211 provided on the distal extremity of the tool 166. Duringthe time that the movement of the sleeve 173 takes place, the innertubular member is held stationary by its engagement with the skirt 181which is connected by the bayonet-type connection hereinbefore describedto the housing 32 of the endoscopy device.

Many of the tools 166 as hereinafter described utilize a commonactuation mechanism 231 shown in FIGS. 14-17 that consists of first andsecond parallel links 232 and 233 which are pivotally connected by alarge rivet to the distal extremity of the link rod 201. The other endof the link 233 is connected by a rivet 236 to the leg 237 of anL-shaped scissor blade 238. Similarly, the other end of the link 232 isconnected by a rivet 239 to a leg 241 of an L-shaped scissor blade 242.The L-shaped scissor blades 238 and 242 are pivotally mounted on anAllen head screw 243 which is mounted in a tool tip 246 formed of asuitable material such as stainless steel.

The tool tip 246 is formed of parts 246a and 246b. Part 246a issemicircular in form as shown in FIG. 16 and is provided withcylindrical recesses 247 to accommodate the rod 201 to permitreciprocatory movement of the rod 201 therein. The two parts 246a and246b are mounted in the distal extremity of the tubular member 267 bysuitable means such as a crimp fit in the form of annular grooves 248 inthe distal extremity of the inner tubular member 167 as shownparticularly in FIG. 14. The inner surfaces of the annular grooves 248frictionally engage the tool tip 246 to retain it in place. The distalextremity of the tool tip 246 is provided with a slot 251 in which theblades 238 and 242 are disposed and which are connected to the links 232and 233 in the manner hereinbefore described. The part 246b is providedwith a well 252 which receives the Allen head screw 243 which isthreaded into the part 246a a shown in FIG. 17 to thereby permit pivotalmovement of the blades 238 and 242 with respect to the screw 243.

When a tool 166 is free and not disposed within an endoscopy device 31,the yieldable spring 182 will push the rod 201 in a direction towardsthe distal extremity to the solid-line position shown in FIG. 14 so thatthe blades 238 and 242 are in the closed position as shown in solidlines. When the tool is placed in the endoscopy device as hereinafterdescribed, the sleeve 173 is moved proximal with respect to the tubularmember 167 against the force of the yieldable spring 182 to move the rod201 towards the proximal extremity to thereby move the rivets 234 to theright as viewed in FIG. 14 to cause the jaws 238 and 242 to be moved tothe open dotted-line position shown in FIG. 14. Thereafter, the triggerbar 81 can be moved to actuate the rod 201 to move the scissor blades238 and 242 to the closed position to perform cutting operations ashereinafter described.

Another tool 256 is shown in FIGS. 18 and 19 which has a proximalextremity which is substantially identical to the tool 166 hereinbeforedescribed. The distal extremity is provided with an actuation mechanism231 of the type utilized in the tool 166 in which L-shaped jaws 257 and258 pivotally mounted on the screw 243 replace the L-shaped scissorblades 238 and 242. The jaws 257 and 258 are formed of a suitablematerial such as stainless steel and are provided with molded coverings261 and 262 formed of a suitable material such as a hard durablepolymeric material. These coverings 261 and 262 are provided with spacedapart serrations or teeth 263 extending transversely of the jaws 257 and258. As shown in FIG. 19, the molded coverings 261 and 262 are formed toleave an elongate annular space 264 extending longitudinally of the jawexposing the stainless steel jaws so that electrocautery functions canbe performed as hereinafter explained. Similarly, a space 264 can beprovided on the opposite side of the jaw also to serve electrocauterypurposes.

Another tool 266 utilizing the actuation mechanism 231 hereinbeforedescribed is shown in FIGS. 20 and 21 and is provided for obtainingbiopsy samples. In this tool 266, oval-shaped clam shells 267 and 268are provided which are pivotally mounted on the screw 243 and which areprovided with lever arms 271 and 272 which are connected to the rivets236 and 239. The clam shells 267 and 268 are formed of a suitablematerial such as stainless steel. The outer surfaces of the clam shells267 and 268 can be covered by a layer 276 of an insulating material sothat all that remains uncovered is a knife-edge like rim 277 on each ofthe clam shells to provide a space 278 therebetween through whichelectrical contact can be made to tissue to perform electrocauteryoperations as hereinafter described.

In FIGS. 22, 23 and 24 there is shown another tool 281. In thisembodiment of the tool, the link member is in the form of a tubularsleeve 282 replacing the rod 201. The tubular sleeve 282 is slidablymounted within the inner tubular member 167 and has its proximalextremity secured to the pin 197 (see FIG. 23) so that as the pin 197 ismoved longitudinally in the inner tubular member 167 the sleeve 282 willalso be moved. A combination hook and scissor device 286 is mounted onthe distal extremity of the inner tubular member 167. This hook andscissor device 286 consists of a fixed part 287 and a movable part 288.The fixed part 287 is provided with a knife edge 291 which is slightlyoffset upwardly as viewed in FIG. 24 from a line perpendicular to theaxis of the inner tubular member 167. The knife edge 291 faces forwardlytoward a notch 292 provided in the fixed part 287. The distal or forwardextremity of the fixed part 287 is provided with a rounded distalextremity 293. The fixed part 287 is semi-circular in cross section asshow in FIG. 25 and is fixed to the distal extremity of the innertubular member 167 by suitable means such as solder (not shown). Themovable part 288 is provided with a hook 296 on its distal extremity.The hook 296 is provided with a portion 296a which extends proximallyinto a cut out 297. The hook 296 is provided with a cutting edge 298which extends perpendicular to the axis of the inner tubular member 167which cooperates with the knife edge 291 provided on the fixed part 287.The movable part 288 is secured to the movable sleeve 282 and if desiredcan be formed integral herewith. A space 299 (see FIG. 23) is providedwithin the inner tubular member 167 to permit movement of the distalextremity of the sleeve 282 with respect to the proximal extremity ofthe fixed part 287. Placement of the tool 281 within the endoscopydevice 31 causes the sleeve 282 to move to the left as viewed in FIG. 23so as to move the cutting edge 298 across the knife edge 291 to thedotted-line position shown in FIGS. 22, 23 and 24.

A bore 301 is provided in the sleeve 282 and makes it possible to supplya liquid saline solution into the scissor device 286 in a mannerhereinafter described.

Another tool 306 is shown in FIG. 26 in which the proximal extremity issimilar to that hereinbefore described with respect to the tool 166 withthe exception that the pin 197 has been eliminated. In this device, aright angle hook 307 formed of a suitable material such as stainlesssteel is provided. The hook 307 is mounted in the distal extremity ofthe inner tubular member 166 in a suitable manner such as by bonding thesame into an insert 308 frictionally disposed within the distalextremity of the inner tubular member 167. The insert 308 is providedwith a bore 309 that is in communication with the bore 168 in the innertubular member 167 so that saline solutions can be introduced or suctioncan be applied to the bore 309 and the bore 168 during use of the tool306.

Another tool 311 is shown in FIGS. 27 and 28 and serves as a spatula. Itis provided with a spatula 312 in the form of a duckbill as shown inFIG. 27. The spatula 312 is formed of a suitable material such asstainless steel. It can be formed as a separate part or formed integralwith a stainless steel cylindrical insert 313 which is frictionallyretained within the distal extremity of the inner tubular member 167.The spatula 312 alternatively can be formed as a separate piece whichcan be welded to the cylindrical insert 313. It is inclined upwardly andtoward the central axis of the tubular member 167 as shown in FIG. 28.Insert 313 is provided with a bore 314 which is in communication withthe bore 168 in the inner tubular member 167 so that the saline solutioncan be introduced through the bore 314 or alternatively suction can beapplied through the bore 314.

An adapter assembly 316 which is a type which can be utilized with thetools hereinbefore described and particularly with respect to tool 311shown in FIGS. 27 and 28 is shown in FIG. 29. This adapter assembly 316consists of a cylindrical sleeve 317 formed of a suitable material suchas stainless steel which is provided with a hub 318. A cylindrical boreextends through the cylindrical sleeves 317 and into the hub 318.Fittings 321 and 322 are mounted on the hub 318 and are provided withflow passages 322, 323 and 324 that are in communication with the bore319. A covering 226 formed of a suitable insulating material such asplastic is provided over the hub 318 and has molded therein anelectrical cable 327 that is provided with multiple conductors as forexample seven which extend to a multiple-pin connector 328. Theelectrical cable 327 also carries another high voltage conductor wire329 which is utilized in electrocautery procedures as hereinafterdescribed and is electrically connected to the hub 318 by suitable meanssuch as by a solder joint 331. The distal extremity of the cylindricalsleeves 317 is swaged outwardly as shown in FIG. 29 to hold the adapterassembly 36 in place in a tool as hereinafter described. Means isprovided for making electrical contact between the inner tubular member167 and the sleeve 317 and consists of another sleeve 332 formed of asuitable material such as brass which is disposed on the exteriorsurface of the cylindrical sleeve 317 and extends from the hub 318 tothe swaged portion 317a. The sleeve 332 is provided with an annularbulge-like portion 332a to facilitate making electrical contact with theinner tubular member 167 while permitting rotation of the inner tubularmember 167 with respect to the sleeve 332.

As shown in FIG. 30, the adapter assembly 16 is adapted to be mounted inthe tool 311 and can be advanced through the hole 219 in the cap 17through the valve member 216 and into the inner tubular member 267 sothat the swaged portion 317 makes good electrical contact with theinterior of the inner tubular member 167. At the same time,communication is established between the bore 319 and the bore 168 ofthe tubular member 167. The connector 328 is connected to the connector157 provided on the endoscopic device 37.

As shown in FIG. 30, a control console 336 is provided for use with theadapter assembly 316. The control console 336 is provided with amicroprocessor 337 and relay control assembly 338. The microprocessor337 and the relay control assembly 338 are connected to a suitablesource of power by a cable 339. The microprocessor 327 and the relaypanel 338 are connected to the cable 327. The relay panel 338 is alsoconnected to electrical solenoids 341 and 342. The solenoids 341 and 342are utilized for controlling the flow of fluids to and from the adapterassembly 316. Thus solenoid 341 is provided with a tube 343 which isconnected to the fitting 322 provided on the adapter assembly 316 andsolenoid 342 is provided with a tube 344 which is connected to thefitting 321 of the adaptor assembly 316. The solenoid 341 is connectedto a suitable source of saline solution by a tube 346 and similarly thesolenoid 342 is connected to a source of vacuum by tube 347.

Operation and use of the hand held surgical device and tools for usetherewith, the assembly thereof and the method may now briefly bedescribed as follows. Let it be assumed that the patient has beenprepared and draped for performing a medical procedure, as for example alaparoscopy for removing a diseased gallbladder. The surgeon places apuncture in the abdomen with a small tool such as a Veres needle. Carbondioxide is introduced into this puncture to cause a partial inflation ofthe abdomen to thereby create a cavity in the abdominal area. The Veresneedle can then be removed, and a trocar can be introduced into theabdomen through the same puncture or in a position adjacent to theneedle. The trocar can be of a conventional type or can be of the typedescribed in U.S. Pat. No. 5,176,648 dated Jan. 5, 1993. With the trocarin place, additional carbon dioxide is introduced into the abdomen tofurther inflate the abdomen to a pressure corresponding to approximately15 mm of mercury. With the abdomen so inflated, an endoscope is insertedinto the abdominal cavity so that the interior of the abdominal cavitycan be visualized on a video monitor. Thereafter, three additionaltrocars are positioned in the abdomen, one adjacent the patient's upperleft-hand portion of the abdomen, another at the upper right-handportion of the abdomen, and the third at the lower right-hand portion ofthe abdomen. These additional sites are used for introduction of varioustools typically utilized during endoscopic surgery. For example, thefour trocars thus far described would be utilized to remove agallbladder. The surgeon, after the trocar is in place, takes theendoscopy device 31 of the present invention and grasps it by either hisright hand or left hand by grasping the pistol grip-handle portion 34.The surgeon then positions the barrel 121 so that it can enter thetrocar and be advanced into the abdomen while the interior of theabdomen is being visualized on the video monitor. The surgeon thenselects the desired tool to be utilized with the endoscopy device 31.For example, the first tool the surgeon may select may be a grasper ofthe type shown in FIGS. 18 and 19. With the grasper 256 locked in placein the endoscopy device 31, the surgeon can manipulate the grasper 256to manipulate the liver and/or the gallbladder by grabbing onto one ofthe organs and pulling on it or pushing on it so that the desiredpositions of the organs are achieved to permit the surgeon to performthe gallbladder removal procedure.

The grasper 256 in its normal position has its jaws 257 and 258 in aclosed position. With the jaws in the closed position, the grasper canbe inserted through the barrel 121 and the tool locked in place by thecap 138 being advanced between the interior of the slider cap 179 andthe legs 76 until the protrusions 180 snap into the annular recess 143to lock the tool in place. This serves to connect the tool mechanism tothe trigger mechanism. Thereafter, upon slight additional inwardmovement of the grasper 256 the bayonet-type lock connection is made bythe protrusions 202 entering into the L-shaped recesses 161 and thenwith a slight grasper 256 it is locked into place. After this has beenaccomplished, the trigger bar 81 can be operated by having the fingersof the hand extend through the hole 106 to cause opening and closing ofthe jaws 257 and 258. When the tool 256 is locked into position ashereinafter described, the jaws 257 and 258 are moved to an openposition and thereafter can be opened and closed by the surgeonoperating the trigger bar 81.

Movement of the trigger bar from 1/2 to 5/8" causes approximately 1/8"of travel of the actuator tube assembly 41, which movement is utilizedto cause opening and closing of the jaws 257 and 258. Because of theapproximately 4-to-1 mechanical advantage which is achieved, theapplication of one pound of force by the surgeon to the trigger bar 81will cause the application of approximately 4 pounds of force by theinside surfaces of the grasper jaws 257 and 258. The mechanism foroperating the jaws 257 and 258 is one in which pushing of the rod 201serves to cause closing of the jaws and pulling of the rod 201 causesopening of the jaws 257 and 258. The mechanical advantage is maximizedat the point of closure, which is achieved by the pushing toggle action.

After the physician has positioned the liver and gallbladder in thedesired positions to achieve access to the desired anatomy, the surgeoncan then utilize another tool, as for example another grasper 256, andinsert it through one or the other ports to dissect the fatty tissuewhich is connected to the gallbladder and which is also connected to thecystic duct and to the cystic artery. After the fatty tissue has beenpulled away from the desired ducts and arteries, the grasper 256 can beremoved from the endoscopy 31 device by giving a slight twist to thetool or grasper 256 to cause the protrusions 191 to move out ofengagement with the L-shaped slots 161 and then pulling the toolrearwardly. As the tool is pulled rearwardly, the outer sleeve 183 withits inclined surface 188 urges the arms 176 inwardly so that theprotrusions 180 clear the annular recess 143 in the cap 138 to permitseparation of the tool from the endoscopy device 31. The tool can bereadily removed through the valve member 136 with the valve member 136retaining a fluid-tight engagement with the tool and, after the tool hasbeen removed, to continue to form a fluid-tight seal with respect to thebore 42 to prevent the escape of carbon dioxide.

Thereafter, the surgeon can take another tool such as a scissors 166 andinsert it into the endoscopy device 31 in the same manner in which thegrasper tool 256 has been inserted and locked into place. After this hasbeen accomplished, the surgeon can operate the trigger bar 81 of thescissors 166 to cause opening and closing of the scissors to cut apathway through the cystic duct.

A catheter (not shown) can then be introduced by the surgeon throughanother trocar and advanced into the ductwork. A radiopaque dye can thenbe introduced through the catheter into the ductwork, and by viewing thesame under x-ray the surgeon can ascertain whether or not in fact he hascut the cystic duct. Assuming that the cystic duct has been severed asdesired, another tool can be introduced through a trocar such as a clipapplier to apply clips to close the cystic duct. A similar procedure canbe utilized for cutting the artery and clipping the same. Once thecystic duct and the artery have been legated, the doctor can cut throughthe cystic duct and the artery without fear of causing internalbleeding. The gallbladder can then be dissected from the liver by use ofthe scissor tool 166, the hook 306 or the spatula 12.

In the removal of the gallbladder it may be desirable to use anadditional tool or another tool such as the spatula tool 311 shown inFIGS. 27 and 28 with an adapter assembly 316 mounted thereon. After thespatula tool 311 has been introduced into the endoscopy device 31 andlocked in place, the spatula 12 can be manipulated to separate thegallbladder from the liver by physical separation utilizing the spatula.Alternatively, electrocautery techniques can be utilized in conjunctionwith the spatula 312 which by operation of the switches 151 and 152 canbe used to burn away the undesired tissue and to perform electrocauterywhere necessary. The electrical arcing created between the spatula andthe tissue will cut through and coagulate away the connective tissuebetween the gallbladder and the liver. In this way, the gallbladder canbe systematically dissected free from the liver.

In the event that there is excessive bleeding or holes are cut intoeither the gallbladder or the liver, it may be necessary to cauterizeand cleanse the area in order to permit the surgeon to continue tovisualize the operations being performed. This can be readilyaccomplished by introducing a saline solution by operating one of theswitches 153 or 154 provided on the sides of the housing 32 of theendoscopy device. These switches can be operated by the fingers of thehand holding the tool. Thus, first, a saline solution can be introducedinto the adapter assembly 316 through the energization of the solenoid341 to cause fluid to pass into the bore 168 of inner tubular member 167and through the bore 314. Similarly, suction can be applied to thesesame passages by energization of the solenoid 342 to cause the salinesolution and other liquids in the cavity to be withdrawn from thepatient. This can be readily accomplished because of the relativelylarge-diameter flow passages provided for introducing liquids such assaline solutions and removing liquids from the abdominal cavity.

After the liquids have been removed from the cavity, the surgeon is freeto continue the procedure, as for example continuing dissection orremoval of the gallbladder from the liver.

After the gallbladder has been separated from the liver, it can beremoved from the abdominal cavity through one of the puncture woundswhich has been formed in the abdominal wall. Alternatively, the surgeoncan utilize a retrieval device such as that disclosed in U.S. Pat. No.5,190,555, dated Mar. 2, 1993, which can be introduced through one ofthe punctures and the gallbladder and its contents placed into the sack.The sack can then be closed and the sack with its contents, namely thegallbladder, bile and stones, can then be pulled through the abdominalpuncture or wound. After the gallbladder has been removed, the othertrocars can be removed, as well as the endoscope. The abdomen is thendeflated or desufflated. The puncture wounds in the abdomen are thenclosed with one or more sutures.

In the procedure hereinbefore described, any of the tools hereinbeforedescribed can be utilized in the procedure, as for example the hookscissors tool 286 shown in FIGS. 22-25. Many of the tools can beutilized as electrocautery devices because of the metal distalextremities can form electrical contact with the tissue on whichelectrocautery operations are to be performed. As explained previously,the adapter assembly 316 can be readily secured to the tool whilemaintaining a fluid-tight connection with the same through the valvemember provided in the tool. Saline introduction and suction operationsalso can be readily performed. It should be appreciated that surgicaldevice 31 and the tools hereinbefore described can be constructed ofnon-ferrous materials such as plastic, aluminum, brass, etc., therebypermitting them to be used in conjunction with magnetic resonanceimaging, x-rays, CT scanning, ultrasound and other imaging techniques.

Another embodiment of a hand-hand surgical device 401 incorporating thepresent invention is shown in FIGS. 31-36 which is provided with ascissors-type hand actuation mechanism rather than a trigger-typehand-actuator mechanism disclosed in the previous embodiments of thehand-held surgical device. The surgical device 401 consists of a housing402 formed in two parts 402a and 402b, each of which has a cylindricalportion 403 and a descending handle portion 404. The two parts 402a and402b are adapted to be fitted together in a suitable manner such as bypush pins (not shown) extending into holes (not shown) provided in theparts 402a and 402b. An actuator tube assembly 411 of the typehereinbefore described is mounted in the upper cylindrical portion 403for limited axial reciprocatory movement. The actuator tube assembly 411is provided with a bore 412 which extends therethrough. The actuatortube assembly 411 is constructed with a trombone-like seal in a mannersubstantially similar to that hereinbefore described with the previousembodiments and thus will not be described in detail.

The actuator tube assembly 411 extends through a rectangular box-likeelectrical housing 416 mounted in the upper cylindrical portion 403 ofthe housing 402 (see FIG. 32). The electrical housing 416 is adapted tointeract with a flex circuit (not shown) of the type described inco-pending application Ser. No. 08/128,309 filed on Sep. 28, 1993. Theflex circuit is connected to two electrical switches 421 and 422 mountedon each of the opposite sides of the housing 416 for "cut" and "coag"functions which are adapted to be operated by push buttons 423 and 424provided on opposite sides of the cylindrical housing 403. The pushbuttons 423 and 424 are adapted to be operated by a finger of the humanhand holding the hand-held surgical device and having the other threefingers extend through the arcuate slot 426 provided in the handleportion 404. This arrangement makes the hand-held surgical device 401ambidextrous so it can be operated equally well by left-handed orright-handed persons. Two other electrical switches 428 for irrigationand 429 for suction are carried by the electrical housing 416 and extendupwardly through the cylindrical portion 403 and are used forcontrolling the introduction of saline solution through a tube 431connected to the device 401 and a tube 432 for supplying suction to thedevice. These two switches are controlled by a rocker switch arm 434accessible from the top of the cylindrical portion 403 of the housing402 and also being adapted to be engaged by the index finger of the handholding the surgical device 401.

Means is carried by the housing 402 for causing reciprocatory movementof the actuator tube assembly 411 consists of a yoke-like member 436which is provided with rounded extremities 437 that engage spaced-apartparallel annular flanges 438 and 439 carried by the actuator tubeassembly 411. The yoke-like member is provided with handle portions 441which extend through a slot 442 provided in the cylindrical portion 403of the housing 402 proximal of the handle portion 404. The handleportions 441 are provided with holes 443 adapted to receive the thumb ofthe hand engaging the handle portion 404.

The yoke-like member 436 is pivotally mounted in the cylindrical portion403 of the housing 402 by pin 444 formed of boss portions 444a and 444bwhich are seated in inwardly extending protrusions 446 provided as apart of the cylindrical portions 403a and 403b.

A nose cone 451 is disposed in the forward extremity of the housing 402.It is threaded onto a cylindrical nose bearing 452 (see FIG. 37). Thenose bearing 452 is provided with an annular recess 453 into which thecylindrical portion 403 extends to permit longitudinal movement of theactuator tube assembly 411. The nose bearing 452 is mounted on thedistal extremity of the actuator tube assembly 411. Cooperative matingmeans is provided for causing rotation of the actuator tube assembly 411as the nose cone 451 is rotated by a finger of the hand as for exampleby the index finger as the hand-held surgical device 401 is held by ahuman hand. Such cooperative mating means takes the form of a key andslot connection in which a key 454 is carried by the nose bearing 453and extends into an elongate slot 455 carried by the actuator tubeassembly 411 (see FIG. 37). This key and slot connection, in addition tocausing rotation of the actuator tube assembly 411 permits longitudinalor axial movement of the actuator tube assembly relative to the nosecone 451. A nose bushing 456 is slidably mounted on the distal extremityof the actuator tube assembly 411 and is provided with a flanged portion456a extending beyond the distal extremity of the actuator tube assembly411. This flange portion is rotatably mounted in an annular recess 457provided on the distal extremity nose cone 451. A cylindrical barrel 458is releasably retained within the nose bushing 456 by a snap-in type ofconnection comprising an annular bead 459 which is adapted to seat in anannular recess provided on the proximal extremity of the barrel 458 (seeFIG. 37). With the construction hereinbefore described, it can be seenthat the barrel 458 can remain stationary when the nose cone 451 isbeing rotated for causing rotation of a tool carried within the barrel458 as hereinafter described.

A passive ratchet mechanism 461 is provided for retaining the actuatortube assembly 411 in a desired axial position as it is advanced byoperation of the thumb handle 441. This ratchet mechanism 461 takes theform of a ratchet pawl 462 pivotally mounted in a boss 403a (see FIG.35) in the housing 402 by a pin 463 extending transversely thereof.Ratchet pawl 462 is adapted to engage ratchet teeth 464 carried by anarcuate surface 466 provided on the thumb handle 441.

A cam mechanism 468 is provided for causing the ratchet pawl 462 toengage the ratchet teeth 464 and consists of push buttons 469 accessiblefrom opposite sides of the housing 402. The buttons 469 have portionsthereof extending through slots 471 connected to a cam member 472 (seeFIG. 36) which is movable sidewise in opposite directions within thehousing 402. The cam member 472 is provided with a vee-shaped slot 473with the legs thereof extending downwardly formed therein. One end ofthe ratchet pawl 462 opposite the pivot pin 463 extends into thevee-shaped slot (see FIGS. 35 and 38) and is centered at the apex of thevee-shaped slot. In this position of the cam member 472, the pawl 462 ismaintained out of engagement with the ratchet teeth 464. A coil spring474 is mounted on the boss 403a and has an end 476 engaging another boss477 on the handle portion 404 and the other end 478 engaging a boss 479on the ratchet pawl 462. The coil spring 474 yieldably urges the cammember 472 so that the apex of the vee-shaped slots brings the ratchetpawl 462 to the central dotted-line portion shown in FIG. 36.

If it is desired to passively engage the ratchet teeth, either of thebuttons 469 can be engaged by a finger of the hand and the cam member472 is pushed sidewise. As this occurs, the end of the pawl 462 remotefrom the ratchet teeth is cammed downwardly with respect to the pivotpoint 463 with the other end being cammed upwardly to engage the ratchetteeth 464. Thus it can be seen that any time that the device 401 isbeing utilized and the thumb is being utilized for operating the thumbhandle 441 to bring it in closer proximity to the handle portion 404,the ratchet teeth are advanced forwardly and the ratchet mechanism 461can be utilized to retain the thumb handle 441 in a desired position bymerely engaging one of the push buttons 469 to cause the end of the pawl462 opposite the portion of the pawl 462 engaging the teeth to be cammeddownwardly to move the pawl into engagement with the teeth to latch thethumb handle 441 in a desired position. It can be seen that thisprocedure can be accomplished either with a button on each sidedepending on whether the person is right-handed or left-handed. In bothcases movement, because of the vee-shaped slot 472, the extremity of theratchet pawl 462 therein will be cammed downwardly against the force ofspring 474 to urge the ratchet pawl 462 into engagement with the ratchetteeth 464. When it is desired to release the pawl 462 from the ratchetteeth 464, it is merely necessary to engage the thumb handle 441 andpush on it slightly to release the ratchet pawl 462 permitting thespring 474 to return the cam member 472 to a central position andpermitting the ratchet pawl to remain disengaged. The thumb handle 441can be released to be yieldably returned to its home position in whichthe actuator tube assembly 411 is located in a proximal position by areturn spring 486 which has one end secured within the thumb handle 441in a suitable manner such as by a pin 487 and which has the other endsecured to the housing 402 by a pin 488. As can be seen from FIG. 34,the return spring 476 extends through a hole 489 the thumb handle 441.

Operation and use of the hand-held surgical device 401 is very similarto that hereinbefore described in connection with the previousembodiments. A tool 491 of the type hereinbefore described can beinserted into the hand-held surgical device 401 in the mannerhereinbefore described and is retained therein. As explained previously,the principal difference between hand-held surgical device 401 and theone previously described is that it utilizes a scissors-type grip ratherthan a pistol-type grip as disclosed in previous embodiments. Thisfeature is advantageous to many surgeons because they are accustomed toutilizing scissors-type devices in surgery. This makes it possible forthe surgeon to utilize the same type of action to which the surgeon isaccustomed in performing surgical procedures. The hand-held surgicaldevice 401 is also advantageous in that it can be utilized equally wellby left-handed or right-handed surgeons because the controls areaccessible from opposite sides and can be operated either by the lefthand or the right hand, depending upon which hand the surgeon desires touse.

Another embodiment of a hand-held surgical device incorporating thepresent invention which is particularly adapted to be utilized by asurgical assistant is shown in FIGS. 38-42. The surgical device 501consists of a housing 502 formed of two parts 502a and 502b and isgenerally in the form of a truncated cone. The housing 502 is providedwith a finger recess 503 which is adapted to be engaged by a finger ofthe hand when the hand-held surgical device 501 is held by a human handas hereinafter described.

An actuator tube assembly 506 is mounted for reciprocatory movementwithin the housing 502 similar to the actuator tube assemblyhereinbefore described. It is provided with a bore 507 extendingtherethrough which is adapted to receive surgical tools of the typehereinbefore described. Handle or trigger means is provided for axiallymoving the actuator tube assembly 506 in the desired reciprocatorymotion. The handle means consists of two parts which are adapted to bejoined together in a suitable manner as for example by the use of pushpins 512 extending into holes 513. The forward extremities of the handleparts 511a and 511b are provided with pivot holes 516 which are adaptedto receive inwardly extending pins 517 provided on upwardly extendingprotrusions 518 formed as a part of the housing 502. The forwardextremities of the handle parts 511a and 511b also carry downwardlyextending protrusions 521 which are disposed between parallel spacedapart annular flanges 522 and 523 provided on the actuator tube assembly506 for causing reciprocatory movement of the actuator tube assembly 506as the handle 511 is pressed towards the housing 502.

This reciprocatory movement of the actuator tube assembly 506 in aproximal direction must be accomplished against the force of a coilspring 526 coaxially mounted on the actuator tube assembly 506. The coilspring 526 has one end engaging an annular flange 527 provided on theactuator tube assembly 506 and has the other end engaging inwardlyextending arcuate protrusions 528 provided in the housing 502 (see FIG.39). A cylindrical member 531 is threadedly mounted on the proximalextremity of the actuator tube assembly 506 by suitable means such as anadhesive (not shown). The cylindrical member 531 is provided with a hole532 therein which opens into the bore 507 of the actuator tube assembly506 so that surgical tools of the type hereinbefore described can beinserted therethrough. The cylindrical member 531 is provided withlongitudinally extending circumferentially spaced apart recesses 533 toaid in gripping the cylindrical member 531 by the fingers of the hand.Bayonet-type recesses 534 are provided on the exterior surface of theproximal extremity of the housing 502.

A nose cone 536 of the type hereinbefore described provided withcircumferentially spaced protrusions 537 on the outer surface thereof isrotatably mounted on the housing 502 and is secured thereto to preventlongitudinal movement of the nose cone 536 with respect to the housing502. The housing 502 is seated in an annular recess 538 provided in thenose cone 536 (see FIG. 40). Cooperative mating means is provided on thenose cone 536 and the actuator tube assembly 506 so that when the nosecone 536 is rotated by a finger of the hand, the actuator tube assembly506 will be rotated while still permitting axial movement of theactuator tube assembly 506. Such cooperative mating means includes a pin539 carried by the nose cone 536 and formed integral therewith which isdisposed in an elongate recess 541 provided on the actuator tubeassembly 506 and extending longitudinally thereof.

A ratchet pawl mechanism 551 is provided for retaining the actuator tubeassembly 506 in a desired axial position as it is being advanced toactuate a tool carried by the device 501 as hereinafter described. Thisratchet pawl mechanism 551 includes a knob or lever 552 mounted in thehandle 511 extending upwardly out of the handle. This knob is adapted toassume three different positions as shown in FIGS. 43A, 43B and 43C. Thefirst position shown in FIG. 43A is the "disengaged position" in whichthe ratchet knob 552 is proximal or to the rear in which the ratchetpawl mechanism 551 is deactivated permitting the trigger handle 511 tomove unimpeded to any position. The second or midpoint position shown inFIG. 43B is the "passive" position in which the ratchet mechanism ispassively engaged as hereinafter described. The third position is shownin FIG. 43C in which the ratchet knob is distal or forward and locks theratchet mechanism.

The trigger knob or lever 552 is formed integral with a generallycylindrical body 553 which is disposed in a cylindrical recess 554provided within the handle parts 511a and 511b and is pivotally mountedtherein on a pin 556 supported by the handle parts 511a and 511b. Thebody 553 is arcuate in shape and is provided with a curved surface 557which travels within the cylindrical recess 554. A rounded protrusion ordetent 558 is provided on the outer surface and is adapted to engage arecess 559 formed in the handle or trigger 511. An arcuate slot 561 isformed in the body 553 and underlies the curved surface 557 to permitinward flexing of the portion of the body overlying the curved arcuateslot 561 so as to provide a spring member yieldably urging the detent558 in an outward direction so it will be yieldably urged into therecess 559 when the lever or knob 552 is operated to move the detent 558into registration with the recess 559. The body 553 is provided with aradially extending depending tab 563 which is adapted to engage a lip564 carried by the upper extremity of a U-shaped pawl 566. The U-shapedpawl 566 is provided with first and second legs 567 and 568 which aregenerally spaced apart and parallel with a lateral extending portion 569which carries the lip 564. Each of the legs 567 and 568 is provided witha hole 571 which is pivotally mounted on a pin 572 carried on the innersurface of a downwardly and proximally extending portion 573 of thehandle 511.

A coil spring 576 (see FIG. 39) is provided and is mounted on the pin553 and is seated within an arcuate recess 577 (see FIG. 42) provided inthe body 553 and has one end 578 of the coil spring engaging a surface579 provided in the body 553 and has the other end 581 extending througha small hole 582 provided in a transverse portion 569 of the pawl 566and serves as an action spring as hereinafter described. Another coilspring 584 is provided which extends over the end 581 of the spring 576and has one end engaging the top surface of the transverse portion 569of the pawl 566 and has the other end engaging the coil spring 576. Thespring 584 serves as a return spring. The legs 567 and 568 of the pawl566 are provided with pawls 586 which are adapted to engage teeth 587provided on inclined curved surfaces 588 of members 589 secured to thehousing 502 by suitable means such as screws 591.

An audio feedback system is incorporated into the hand-held surgicaldevice 501 and consists of longitudinally extending slots 593 which areprovided on the actuator tube assembly 511 (see FIG. 39) immediatelyforward of the coil spring 526. The peaks and valleys formed by theselongitudinally extending slots 593 on the actuator tube assembly 511 areengaged by a pin 594 yieldably urged in toward the actuator tubeassembly 511. The pin 594 extends through a hole 596 provided in themember 589 carrying the teeth 587. The pin 594 is carried by flangesleeve 596 disposed on the other side of the member 589 which isslidably mounted on a cylindrical protrusion 597 carried by the housingpart 502a. A coil spring 598 is disposed on the sleeve and has one endengaging the flange portion as shown in FIG. 41 and has the other endengaging the inner surface of the body part 502a. With such aconstruction, it can be seen that as the actuator tube assembly 506 isrotated, click-click sounds will appear as the longitudinally extendingslots are rotated past the pin or plunger 594 to audibly inform thesurgeon of the rotation of the actuator tube assembly 506 and the speedof rotation by the rapidity at which the clicks are heard by thesurgeon. The pin 594 also serves as a detent to yieldably retain theactuator tube assembly 506 in a desired position when the actuator tubeassembly 506 is not being moved.

Operation and use of the hand-held surgical device 501 may now bebriefly described as follows. Let it be assumed that a laparoscopicprocedure is taking place and that the surgeon has an assistant who isutilizing the hand-held surgical device 501 shown in the drawings. Letit also be assumed by way of example that the surgical assistant wishesto utilize the hand-held device for use with a tool such as a grasper599 having openable jaws 600. Let it be assumed that a gall bladderlaparoscopic procedure is being performed and that it is desired toutilize the grasper 591 to pull up and expose the gall bladder so thatit can be surgically removed by the surgeon performing the procedure.The assistant utilizes the hand-held surgical device 501 to introducethe grasper 591 through a trocar cannula (not shown) already introducedinto the body of the patient. During the introduction, the handle 511 isengaged by the palm of the hand and the palm of the hand is utilized tohold the housing 502 which serves as a support for the grasper 599. Theassistant compresses the handle 511 against the housing 502 to close thejaws 600 of the grasper 599 and introduces the grasper 599 into the bodycavity of the patient into the vicinity of the gall bladder. The handle511 can then be released to permit the actuator tube assembly 506 tomove proximally under the force of the coil spring 526 to cause the jaws600 of the grasper 599 to open. The grasper 599 then can be advancedover the gall bladder and the gall bladder clamped between the jaws 600by using the fingers of the hand to press downwardly on the handle 511to cause advancement of the actuator tube assembly 506 to cause closingof the jaws in the manner hereinbefore described in the previousembodiments.

Operation and use of the ratchet mechanism 551 provided in the hand-heldsurgical device 501 may now be briefly described in connection with thetasks being performed by the surgeon's assistant. As pointed out above,the ratchet knob or lever 552 is movable into three positions.

The surgeon's assistant during an initial introduction may wish to holdthe ratchet knob 552 and may wish to bring back the ratchet knob to aproximal position so that the ratchet mechanism 551 is inoperative asshown in FIG. 43A. Thereafter let it be assumed that the grasper 599 hasbeen moved into the vicinity of the gall bladder with the jaws 600 in anopen position. After the jaws 600 have been moved onto the gall bladder,the assistant may move the ratchet knob 552 to an intermediate positionto that shown in FIG. 43B in which the pawls 586 have been moved intoengagement with the ratchet teeth 576 overcoming the force of the returnspring 584 and moving the pawls 586 into engagement with the ratchetteeth 587. When this is the case, the handle 511 can be progressivelypressed against the body 502 to cause the pawls 586 to progressivelyadvance in the ratchet teeth and click by successive ratchet teeth tolatch the handle 511 in the successive positions as it is advanced andas the jaws 600 are being closed on the gall bladder. If during thisprocedure it is desired to release the gall bladder and take anothergrasp, this can be readily accomplished merely by pressing on the lever511 permitting the pawls 586 to disengage from the teeth and to permitthe grasper to open under the force of the coil spring 526.Alternatively, the handle 511 can continue to be compressed until thegall bladder has been firmly grasped during which time the pawls 586will progressively advance in the ratchet teeth 587 and be retainedtherein.

As soon as the assistant has ascertained that the jaws 600 have firmlygrasped the gall bladder which can be ascertained by the surgeon's feelof the resistance provided by movement of the handle 511, the ratchetmechanism can be placed in a locked position by moving the ratchet knob552 to the forwardmost or distal position shown in FIG. 43A so that thetab 563 carried by the body 553 engages the lip 564 and urges the pawls586 into engagement with the ratchet teeth 587 to retain the sametherein and to thereby lock the grasper onto the gall bladder. Thesurgeon's assistant can then release the handle 511 with the grasperhaving a firm grasp on the gall bladder.

It should be appreciated that in connection with the use of thehand-held surgical device 551, that the surgeon's assistant whileutilizing the grasper 599 can rotate the grasper 599 if that is desiredduring the procedure. This can be readily accomplished while utilizingthe index finger of the hand holding the device 501 to rotate the nosecone 536 in the desired direction. As this is being accomplished,audible sounds will be given out by the pin 594 engaging with the slots593 carried by the actuator tube assembly 506. The pin 594 serves as adetent and retains the actuator tube in the desired position.

From the foregoing it can be seen that in the embodiment of thehand-held surgical device 501 hereinbefore described there has beenprovided a device which is relatively lightweight, simple and compact.It can be produced relatively inexpensively since a number of featuresprovided on the hand-held surgical devices hereinbefore described havebeen eliminated and in particular the electrical functions which havebeen eliminated. Even without these additional features, the hand-heldsurgical device has many desirable features. It is small and compact andcan be readily used. It is particularly adapted for use with tools suchas graspers which may require the use of a ratchet mechanism to aid inretaining the grasper in engagement with the tissue being engaged by thegrasper.

Another hand-held surgical device 601 is shown in FIGS. 44-48 andincorporates another embodiment of the hand-held surgical device of thepresent invention. The device 601 is particularly adapted for use ingynecological surgical procedures where it is desired that the toolsbeing utilized with the hand-held surgical device be utilized in avertical orientation. The hand-held surgical device 601 for that reasonhas been provided with a vertical hand grip. The hand-held surgicaldevice 601 consists of a housing 602 which is configured to fit in thepalm of a human hand. Thus the housing 602 is provided with anindentation 603 which is adapted to receive the palm of the hand, thehousing being formed so that the fingers can extend around the housingand extend through and into a large elongate hole 604 provided in atrigger handle 606. The handle is provided with a recess 607 which isadapted to receive the index finger of the hand. The housing 602 isprovided with inclined outwardly extending surfaces 608 on oppositesides of the housing 602 which are provided with spaced apart parallelraised protrusions 609 which are adapted to be engaged by the thumb ofthe hand to provide a counterforce to the finger action on the triggerhandle 606.

An actuator tube assembly 611 similar to that hereinbefore described ismounted for reciprocatory movement in the housing 602 in a verticaldirection and is provided with a bore 610. The actuator tube assembly611 includes a trombone-like connection hereinbefore described for theprevious embodiments. Means is provided for causing reciprocatorymovement of the actuator tube assembly 611 and consists of a yoke 612which is pivotally mounted on a pin 613 carried by the housing 602 (seeFIG. 45). The distal extremity of the yoke 612 is pivotally connected bya pin 614 to the trigger handle 606. The proximal extremities of theY-shaped yoke 612 is rounded as shown in FIG. 45 and is disposed betweenfirst and second annular flanges 616 and 617 provided on the actuatortube assembly 611. The trigger handle 606 is mounted for movement in anelongate slot 618 provided in the housing 602 for movement into and outof the housing. This is accomplished by utilizing an idler arm 619 whichhas one end pivotally connected to the trigger handle 606 by a pin 621and which has the other end secured to the housing 602 by a pin 623. Theidler arm 619 is disposed generally parallel to the yoke 613 to ineffect provide a parallelogram-type motion for the trigger handle 606.Spring means in the form of U-shaped spring 621 is provided within thehousing 602 for yieldably urging the trigger handle 606 into anoutermost position through the slot 618 as determined when the actuatortube assembly 611 is in its proximal most or rearmost position withinthe housing 602. One end of the U-shaped spring 621 engages a pin 622 inthe housing 602 and the other end engages the pin 614 carried by thetrigger handle 606.

Because of the vertical orientation of the hand-held surgical device 601it is necessary to provide means for rotating the actuator tube assembly611 which is accessible to the fingers of the hand holding the hand-heldsurgical device 601. As shown particularly in FIGS. 45 and 46, a rightangle transfer rotation mechanism is provided which takes the form of athumb wheel 626 which is accessible through slots 627 provided onopposite sides of the housing 602. Thumb wheel 626 is provided withrecesses 628 spaced apart circumferentially of the thumb wheel 626 whichis adapted to be readily engaged by the thumb. The thumb wheel 626 isalso provided with axially disposed cylindrical protrusions 629 forrotatably mounting the thumb wheel 626 in the structure of the housing.As shown, the thumb wheel 626 is mounted so that it is disposed in oneside of the actuator tube assembly 611. Thumb wheel 626 is provided withadditional cylindrical protrusions 631 which are spaced apartcircumferentially and extend at right angles to the recesses 628.Protrusions 631 are adapted to mate with a gear 632 which is providedwith longitudinally and axially extending slots spaced circumferentiallyaround the gear 632. The gear 632 is affixed to the actuator tubeassembly 611 and can be formed integral therewith. Thus it can be seenthat as the thumb wheel 626 is rotated by the thumb of the hand holdingthe device 601. The rotary motion of the thumb wheel 626 is translatedinto rotary motion of the gear 632 in a direction which is at rightangles to the rotation of the thumb wheel 626.

A ratchet mechanism 641 is provided in the housing which consists of aU-shaped pawl member mounted within the housing. The U-shaped pawlmember 642 is provided with legs 643 and 644 which carry pawls 646 (seeFIG. 45) which are adapted to engage teeth 647 by two spaced-apartportions 606a and 606b of the trigger handle 606 (see FIGS. 45 and 47).A U-shaped pawl 642 is provided with cylindrical protrusions 651 whichextend through the housing 602 and are connected to knobs 652 providedon opposite sides of the housing 602. The knobs 652 are provided withoutwardly projecting protrusions 653 adapting the knobs to be engaged bythe thumb of the hand holding the device 601. The knobs 652 are operableto swing the pawls 646 into engagement with the teeth 647. By swingingmovement of the knobs 652 which are movable in the direction indicatedby the arrow 654 (see FIG. 44) the knobs 652 are moved into and out ofrecesses 656 formed in the outer surface of the housing 602.

As described with the previous embodiment of the hand-held surgicaldevice shown in FIG. 31, the device is provided with cut and coag pushbuttons 661 and 662 which are adapted to be engaged by the index fingerof the hand engaging the handle. It is also provided with a rocker arm666 mounted on the housing 602 which is adapted to be engaged by thethumb of the hand for movement between the two positions for operatingtwo switches (not shown) for performing suction and liquid delivery ashereinbefore described. These switches 661, 662 and 666 are connected toelectrical circuitry of the type described in co-pending applicationSer. No. 07/757,343, filed Sep. 10, 1991, and are connected to a flexcircuit which in turn is mounted within the housing (not shown) andconnected to a cable 671. A nut 676 of the type hereinbefore describedis mounted on the actuator tube assembly 611. A bayonet-type recess 677for mating with surgical tools as hereinbefore described is provided onthe housing 602.

An outer tubular member 681 formed of a suitable material such asplastic is secured to a nose cone 682. The nose cone 682 is secured tothe housing 602 in a suitable manner such as a threaded connection (notshown). It carries a cylindrical tube 686 which is slidably mounted overa metal tube 687 mounted on the distal extremity of the actuator tubeassembly 611 to provide a trombone-like slide connection hereinbeforedescribed.

Spring means is provided for yieldably disengaging and returning thepawl 642 and for yieldably returning the knobs 652 into positions sothey are disposed within the recesses 656 provided in the housing 602.The spring means consists of a coil spring 657 which is mounted on thepin 621 and has one end 658 engaging a protrusion 642a and has the otherend 659 engaging the housing 602.

Means is provided for giving an audible indication of the rotation ofthe thumb wheel 626 and consists of a U-shaped spring member 634 (seeFIG. 45 and 46). One end of the spring member 634 is provided with avee-shaped detent 636 which is adapted to engage vee-shaped recessesspaced circumferentially apart on the thumb wheel 626 opposite theprotrusions 631. The other end of the U-shaped spring member 636 issuitably retained in the housing as for example by mounting the same onrib portions 638 carried by the housing 602. In this way it can be seenthat as the thumb wheel 626 is advanced, a click sound will be given bythe advancement of the vee-shaped detent 636 into and out of therecesses 637 as the recesses are advanced past the detent 636 to thusgive the surgeon utilizing the device an audible indication of theamount of rotation and to stabilize the rotary position.

From the foregoing it can be seen that there has been provided ahand-held surgical device of various configurations which all utilize atool actuator tube assembly. Each configuration has advantages ashereinbefore described.

What is claimed is:
 1. A hand-held surgical device for use with a tool having proximal and distal extremities, the tool having tool parts and an actuation mechanism for operating the tool parts, the tool parts being disposed at the distal extremity of the tool and the proximal extremity being sized to be adapted to be grasped by the human hand and for use in performing a laparoscopic medical procedure comprising a handle assembly having proximal and distal extremities and having a bore extending therethrough from the proximal extremity to the distal extremity, said bore being sized so that the tool can be removably positioned within the bore so that the tool parts extend out of the bore at the distal extremity of the handle assembly and so that the proximal extremity of the tool remains out of the bore at the proximal extremity of the handle assembly to permit the tool to be grasped by the human hand to facilitate positioning of the tool within the bore, said handle assembly including hand operated means adapted to cause operation of the actuation mechanism of said tool and for causing rotational movement of the tool.
 2. A device as in claim 1 wherein said hand operated means includes a handle member movable towards and away from the housing.
 3. A device as in claim 1 wherein said handle assembly is formed so that it is adapted to be engaged by the human hand and to be held in a generally vertical position and a trigger handle movable in a direction generally perpendicular to the vertical position.
 4. A device as in claim 3 wherein said handle assembly includes means for mounting said trigger handle so that it moves in a parallelogram-like fashion.
 5. A device as in claim 3 together with means carried by the housing adapted to be grasped by the thumb of the human hand so as to provide a counterforce to the finger actuation of the hand on the trigger handle.
 6. In a hand-held surgical assembly for use in performing a laparoscopic medical procedure, a hand-held endoscopy device having distal and proximal extremities and having a bore extending therethrough from the distal extremity to the proximal extremity, said hand-held endoscopy device having a handle assembly adapted to be grasped by the human hand, operable tool means removably mounted in said bore of the device and having a proximal portion thereof extending out of the proximal extremity permitting the same to be grasped by the hand to aid in inserting the operable tool means into the bore in the device and removal of the operable tool means from the bore of the device, said operable tool means including tool parts and an actuation mechanism for operation of the tool parts, said operable tool means and said handle assembly including cooperative means for establishing a substantially fluid-tight seal in said bore between the handle assembly and said operable tool means and hand-operated means carried by the handle assembly and connected between the handle assembly and the operable tool means to cause operation of the tool parts of the operable tool means.
 7. An assembly as in claim 6 together with an adapter removably and rotatably secured to said operable tool means, said operable tool means having a bore therein in communication with the bore in the device, said adapter having a bore therein in communication with the bore in said operable tool means, means carried by said operable tool means for establishing a fluid-tight connection between the bore in said operable tool means and the adapter.
 8. An assembly as in claim 7 further including switch means carried by the device for causing a liquid to be delivered to the bore in said device or alternatively to provide a vacuum to the bore in said device.
 9. An assembly as in claim 7 further including switch means carried by the device for supplying electrical energy to the operable tool means to perform electrocautery operations and electrical cable means carried by the adapter and connected to said switch means.
 10. A device as in claim 1 wherein said tool parts are in the form of serrated jaws.
 11. A device as in claim 10 wherein said serrated jaws are formed of a metal and further including a covering mounted on said jaws and having spaces therein exposing the metal of the jaws.
 12. A device as in claim 11 wherein said tool parts are in the form of opposed clam shells.
 13. A device as in claim 12 wherein said clam shells have exposed exterior surfaces and metal knife-like edges and further including insulating material covering substantially all of the exterior surfaces of the clam shells but excluding the knife-like edges.
 14. A device as in claim 6 wherein one of said tool parts is provided with a hook-like portion.
 15. In a method for performing a medical procedure in a patient by the use of a hand-held endoscopy device having a bore extending therethrough and a plurality of surgical tools, introducing the endoscopy device into the patient, introducing one of the surgical tools through the bore in the endoscopy device and performing electrocautery operations during the time that the tool is in place in the hand-held endoscopy device, removing the tool after the medical procedure has been completed and thereafter removing the hand-held endoscopy device from the patient.
 16. A surgical tool for use with a hand-held endoscopy device comprising an elongate tubular member having proximal and distal extremities, first and second jaw members pivotally mounted on the distal extremity of said elongate tubular member, means carried by the elongate tubular member for moving the first and second jaw members between open and closed positions, said first and second jaw members being formed of metal and molded coverings formed on the said jaw members formed of a durable hard plastic material and having serrations therein.
 17. A tool as in claim 16 wherein said plastic material is a polymeric material.
 18. A tool as in claim 16 wherein said covering is formed to provide spaces therebetween to expose the metal of the jaws so that the tool can be utilized for electrocautery.
 19. A tool as in claim 18 wherein said serrations extend transversely of the jaws and wherein said coverings are formed to provide an elongate space extending longitudinally of the jaws. 